Immunoblotting with trypomastigote excreted-secreted antigens (TESA blot) of Trypanosoma cruzi was evaluated as a method for diagnosis of chronic and acute phases as well as congenital (in newborn children) Chagas' disease. Serum samples from acute-phase and congenital infections were considered to be positive when they reacted with ladder-like bands of 130- to 200-kDa antigens, recognized by immunoglobulin M (IgM) and IgG antibodies, while IgG from chronic-phase sera recognized a broad band antigen of 150 to 160 kDa. Nonchagasic sera were not reactive to these antigens. The study was carried out on 512 patients, 111 of whom were nonchagasic but included cases of leishmaniasis or other pathologies, and 401 chagasic patients. The latter group comprised 361 chronic cases, 36 acute cases, and 4 congenital cases in newborn children. Among the chronic cases, 256 were from areas in which T. cruzi is endemic but which differed widely in the pathogenic expression of T. cruzi infection and in parasitemia levels. These patients at the same time showed a broad range of low, medium, and high reactivity to conventional enzyme-linked immunosorbent assays and indirect immunofluorescence serotests for Chagas' disease. For these reasons they may better represent the universe of chagasic patients than would a sample of highly reactive sera obtained from chagasic patients in a single area endemic for T. cruzi. All acute and congenital cases showed positivity in the IgM and IgG TESA blots, while chronic cases were 100% positive for IgG antibodies. In nonchagasic sera, including 30 cases of visceral and muco-cutaneous leishmaniasis, the specificity index was 1.000, and no cross-reactions were observed. The TESA blot thus seems to be useful as a sensitive and specific diagnostic assay in cases of suspected acute or congenital T. cruzi infection and as a general confirmatory test for conventional Chagas' disease serology.
SUMMARYThe diagnosis of American cutaneous leishmaniasis (ACL) is frequently based on clinical and epidemiological data associated with the results of laboratory tests. Some laboratory methods are currently being applied for the diagnosis of ACL, among them the indirect immunofluorescence reaction (IIFR), the Montenegro skin test (MST), histopathological examination, and the polymerase chain reaction (PCR). The performance of these methods varies in a considerable proportion of patients. After the standardization of an immunoenzymatic test (ELISA) for the detection of IgG in the serum of patients with ACL using a crude Leishmania braziliensis antigen, the results obtained were compared to those of other tests routinely used for the diagnosis. The tests revealed the following sensitivity, when analyzed separately: 85% for ELISA IgG, 81% for PCR, 64.4% for MST, 58.1% for IIFR, and 34% for the presence of parasites in the biopsy. ELISA was positive in 75% of patients with ACL presenting a negative MST, in 84.8% of ACL patients with negative skin or mucous biopsies for the presence of the parasite, and in 100% of cases with a negative PCR. Thus, ELISA presented a higher sensitivity than the other tests and was useful as a complementary method for the diagnosis of ACL.
The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.
Resistance to Mycobacterium tuberculosis is a reality worldwide, and
its diagnosis continues to be difficult and time consuming. To face this challenge,
the World Health Organization has recommended the use of rapid molecular tests. We
evaluated the routine use (once a week) of a line probe assay (Genotype
MTBDRplus) for early diagnosis of resistance and for assessment
of the main related risk factors over 2 years. A total of 170 samples were tested: 15
(8.8%) were resistant, and multidrug resistance was detected in 10 (5.9%). The
sensitivity profile took 3 weeks (2 weeks for culture and 1 week for rapid testing).
Previous treatment for tuberculosis and the persistence of positive acid-fast smears
after 4 months of supervised treatment were the major risk factors observed. The use
of molecular tests enabled early diagnosis of drug-resistant bacilli and led to
appropriate treatment of the disease. This information has the potential to interrupt
the transmission chain of resistant M. tuberculosis.
Foi realizado estudo epidemiológico com vistas a determinar a prevalência de marcadores sorológicos de hepatite B na população de um pequeno município, de características rurais, do Estado de São Paulo. Observou-se prevalência total de marcadores igual a 7,74%, com valores de HBsAg, anti-HBs e anti-HBc, respectivamente iguais a 0,10%, 1,69% e 7,64%. Ressalta-se a importância da determinação do anti-HBc em estudos epidemiológicos, bem como discute-se a relevância de se comparar a reduzida circulação viral, observada na área, com as elevadas prevalências verificadas em outras regiões, buscando assim levantar hipóteses acerca de mecanismos alternativos de transmissão.
Introduction: Pseudomonas aeruginosa isolates related to nosocomial infections are often resistant to multiple antibacterial agents. In this study, antimicrobial combinations were evaluated to detect in vitro synergy against clinical isolates of P. aeruginosa. Methods: Four clinical P. aeruginosa isolates were selected at random among other isolates from inpatients treated at the public University hospital in Ribeirão Preto, SP, Brazil. Two isolates were susceptible to imipenem (IPM-S) and several other antimicrobials, while the other two isolates were imipenem and multidrug resistant (IPM-R). The checkerboard method was used to assess the interactions between antimicrobials. Results: Combinations of imipenem or other anti-Pseudomonas drugs with complementary antibiotics, such as aminoglycosides, fosfomycin and rifampin, reached synergy rates of 20.8%, 50%, 62.5% and 50% for the two IPM-S and two IPM-R Pseudomonas isolates, respectively. Imipenem, piperacillin-tazobactam and ceftazidime yielded a greater synergy rate than cefepime or ciprofl oxacin. Synergist combinations were more commonly observed when the complementary drug was tobramycin (65%) or fosfomycin (57%). Conclusions: Some antibacterial combinations led to signifi cant reductions of the minimum inhibitory concentrations of both drugs, suggesting that they could be clinically applied to control infections caused by multidrug-resistant P. aeruginosa.
RESUMO
Este trabalho objetivou investigar a prevalência de infecção pelo vírus da hepatite C e identificar possíveis fatores de risco para sua transmissão, em 406 indivíduos portadores do vírus da imunodeficiência humana 16% (IC: 12,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]6Indivíduos portadores do vírus da imunodeficiência humana (VIH) estão freqüentemente co-infectados com outros vírus, incluindo-se os das hepatites. A possibilidade de associação do VIH com o vírus da hepatite C (VHC) em um mesmo indivíduo está facilitada, uma vez que apresentam vias de contágio semelhantes. Assim, grande número de situações consideradas de risco são comuns a ambos. Alguns trabalhos sugerem a ocorrência de interações biológicas entre esses vírus, na presença de co-infecção determinando, assim, alterações no curso clínico e mesmo no processo de transmissão dessas infecções. No entanto, o tema ainda é controverso, necessitando de mais estudos para que se possa obter conclusões mais definitivas.
Revista da Sociedade Brasileira de Medicina Tropical 37 (Suplemento II), 2004HEPATOLOGIA TROPICAL
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